Angka kematian ibu (AKI) di Indonesia masih tergolong tinggi (373 per 100.000 kelahiran hidup, SKRT 1995). Setelah melalui penelusuran oleh WHO melalui Prevention of Maternal Mortality Network diketahui ada 3 keterlambatan yang terjadi. Pertama terlambat membuat keputusan di tempat tinggal pasien, kedua terlambat merujuk ketempat yang lebih mampu untuk menangani dan ketiga terlambat memberi pertolongan setelah berada di rumah sakit. Dalam sebuah penelitian di Afrika didapati waktu tunggu penanganan kasus gawat darurat berkisar antara 2,6 jam hingga 15,5 jam. Untuk mengetahui keadaan di Pontianak dibuat sebuah penelitian mengenai waktu tunggu kasus gawat darurat kebidanan yang dirujuk atau datang sendiri ke rumah sakit. Penelitian dilangsungkan selama 8 minggu sejak 15 September hingga 15 Nopember 2000. Sampel diambil secara purposif sejumlah 35 kasus. Faktor-faktor yang diduga mempengaruhi waktu tunggu persiapan operasi kasus gawat darurat kebidanan diteliti antara lain karakteristik pasien (pendidikan pasien, kadar Hb pasien, pendidikan suami, kehadiran suami, penghasilan keluarga) karakteristik sumber daya rumah sakit (kesibukan dokter jaga, bidan, dokter operator, staf kamar operasi) karakteristik fasilitas (kesibukan kamar operasi, waktu persiapan alat operasi) karakteristik administrasi (mendapatkan ijin operasi) dan karakteristik penunjang (tersedianya darah). Hasil penelitian memperlihatkan rerata waktu tunggu 8 jam 16 menit dengan nilai median 5 jam 45 menit. Waktu terpendek 30 menit dan terpanjang 25 jam 36 menit. Panjangnya waktu tunggu disebabkan oleh kondisi pasien. Sebagian variabel yang diteliti tidak ada hubungan bermakna kecuali kadar Hb dan waktu persiapan kamar operasi. Variabel waktu persiapan kamar operasi ternyata merupakan faktor paling dominan. Disarankan untuk meningkatkan mutu pelayanan secara keseluruhan dan memperpendek waktu tunggu agar menempatkan bank darah didalam rumah sakit dan persiapan kamar operasi lebih baik lagi. Bagi pasien yang akan dirujuk diupayakan agar tetap berada dalam kondisi terbaiknya. Selain itu juga dianjurkan membuat dan membina jaringan kerjasama antara rumah sakit dan Puskesmas serta mencoba mendapatkan cut off point waktu tunggu melalui organisasi profesi (POGI).

Waiting Time Analysis of Preparation Operation for Obstetric Emergency Cases in Hospitals in Pontianak in the Year 2000The Maternal Mortality Rate in Indonesia is still high with 373 deaths per 100.000 live birth(SK.RT 1995). WHO through Prevention of Maternal Mortality Network had found that there were 3 categories of late in helping the patients. The first is "late to decide" by the family, second is "late to refer" to the hospital and the third is "late to take care the patient inside the hospital by the health personnel". Former study in Africa for waiting time was found that it need between 2,6 to 15,5 hours for a patient to wait until she got a help. This study was trying to know the waiting time for an emergency case in obstetric begins when she arrived until she got medical interventions such as cesarean section or laparotomy. The study was carried out for about 8 weeks, from 15th of September until 15th of November 2000. The samples were taken by purposive method and a total of 35 cases were achieved during this study period. Many factors were correlated to the waiting time such as characteristics of the patients (education, hemoglobin value, education of her husband, husband present in the hospital) characteristics of personnel of the hospital (level of occupancy of the doctor in charge, the midwife, the obgyn and the staff of the operation room)characteristics of the facility of the operation room (readiness of the operation room, readiness of the equipment) characteristic of getting the letter of inform consent (time to get the agreement) characteristic of the other (readiness of the blood). The result of this study found that the waiting time's mean was 8 hours 16 minutes. The median was 5 hours 45 minutes and the range was 30 minutes to 25 hours 36 minutes. The causes of the length of the waiting time were patients? condition. There were no significant variables except hemoglobin value and preparation of the operation room's time. With the backward method of linear regression the time for preparation of the operation room was the most dominant variable. To improve the quality in health services and make the waiting time shorter, it is suggested to make preparation time faster, organized a blood bank inside the hospital and referred patient in her best condition. Also suggested to build and maintain good networking between hospital and health center and try to find the cut off point of waiting time through the Indonesian Society of Obstetric and Gynecologist (ISOG).

Sejalan dengan gencarnya isu reformasi, desentralisasi dalam bcntuk otouomi daerah menj adi tuntutan banyak pihak_ Pada akhirnya, pemberlakuan otonomi daerah ini akan membawa dampak hagi bidang kesehatan, yang sa\ah satunya adalah Puskesmas. Maka dari itu, mengantisipasi kemungkinan timbulnya masalah yang lebih besar, Puskesmas diarahkan menj adi unit swadana daerah. Berkaitan dengan hal di atas, penelitian ini bertujuan untuk mengidentiiikasi transformasi Puskesmas Swadana, dengan fokus kajian pada proses perencanaan dan pengeiolaan penerimaan fungsionnl pada Puskcsmas Swadana di DK] Jakarta, tepatnya di Puskesmas Kecamatan Tebet dan Jatinegam. Proses perencanaan dan pengclolaan pcnerimaan fungsional ini akan dibandingkan secara vertikal dan horisontal Penelitian ini merupakan studi kasus dengan menggmmakan pendekatan kualitatif Data diperoleh melalui observasi, penelusuran data sekunder, dan wawanoara mendalam dengan 10 [nforman di Puskesmas Kecamatan Tebet dan 6 informan di Puskesmas Kecamatan Jatinegnra. Informan ini adalah orang-orang yang berkepentingan dan memahami proses pembahan yang texjadi di kedua Puskesmas ini ketika menjadi Puskesmas Swadana - meskipun dalam SK Gubemur No. 39 Tahun 2000 masih disebut sebagai uji coba unit swadana daerah. Hasil penelitian menunjukkan bahwa secara persamaan antara sebelum dan sesudah swadana adalah proses perencanaan mengikuti tahapan-tahapan mulai dad analisis situasi sampai pada penyusmman rencana operasional dan sumber peneximaan fungsional berasal dan reuibusi pasien. Sementara ing perbedaan antara sebelum dan sesudah menjadi Puskesmas Swadana antara lain bahwa setelah menjadi Puskesmas Swadana terdapat kemandirian dalam proses percncanaan (bottom up planning; integrated planning with budgetting dan target-based budgettfng), pengelolaan 100% penerimaan fimgsional, berlaku reward system, kapasitas sumber daya manusia diperhatikan, dan perubahan struktur organisasi yang lebih disesuaikan dengan kebutuhan, dibandingkan bila sebelum swadana, tidak ada kemandirian dalam proses perencanaan (top dawn planning, _fragmented planning with budgetting dan budget- based activities), tidak memiliki wewenang dalam xnengelola penerimaan fmmgsional (l00% disetor kc kas daerah), tidak berlaku reward system secara jelas, pautisipasi staf rendah dan struktur organisasi sama dengan struktur organisasi Puskesmas lainnya di Indonesia. Hasil penelitian juga menunjukkan bahwa di antara kedua Puskcsmas swadana jugs mcmiliki persamaan mendasar, antara lain kemandirian proses perencanaan (bottom up planning, integrated planning with budgetting target-tiased activities), pengelolaan pcnerimaau imgsional (sistem sam pintu, transparan, ada kriteria pexnbagian insentif), proses dimulainya keswadanaan (1 April 2000), legal aspect (SK. Gubernur No. 39 Tahun 2000) dan tahapan-tahapan yang dilalui untuk mcnjadi Puskesmas Swadana (tahap intemal dan ekstemal). Sementara itu, perbedaannya terletak pada optimalisasi partisipasi staf pada proses permcanaan (tinggi vs. cukup tinggi, teamwork solid vs. kurang solid, dukungan tinggi vs. rendah, manajemen partisipatif vs. representative), pola dalam pengelolaan pcnedmaan fungsional (sentralistik vs_ desentralistik), kedisiplinan staf (ketat vs. longgar, sistem amano vs. absen tertulis), teknik pencatatan keuangan (komputerisasi vs manual), proses keswadanaan (sudah slap sebelumnya vs. bclum begitu siap sebelumnya), perubahan (segmental vs. mcnyeluruh), serta pola pembagian insentif Pada dasamya, Puskesmas Swadana membawa banyak manfaat, - texutama bagi peningkatan kemandirian dan mutu pelayanan -, sehingga dapat dikembangkan lcbih lanjut pada masa mendatang.

Abstract Reformation issues has pointed desentralization willing in an district autonomous type being larger. At last, this district autonomous will bring some impacts to health sector, like public health centre. Therefore, to anticipate the bigger problems, public health centre is directed to self financed organization. This research aims at identifying self financed public health centre transformation, focused at planning and revenue management process. This reaserch is located at self financed public health centre in Jakarta, those are Tebet and Jatinegara. Both of process will be compared lvertically and horizontally. This research is case study with qualitative approach It used observation, secondary data collection, and indepth interview to collect data. Indepth interview was conducted with ten informants in Tebet Public Health Centre and six informants in Iatinegara Public Health Centre. They were chosen because they had been considered lmow well about the process explored. For information, these Public Health Centres is called self iinanced, although the Decree of District Government is still in the process. The results show that generally, there are the some processes that similar before and afier become self financed public health centre, they are 1). Planning process follows the same steps from situational analysis to plan of action arrangement and 2). The revenue is gotten hom patients retribution. The diierences are that alter become an self financed organization their planning process use bottom up planning approach more, integrated planning with budgetting and target-based budgetting, 100% of their revenue is managed by themselves, reward system, care of human resources capability, and the change of organizational structure is suitable with the needs. Before become a self financed organization, their planning are dominated by top down planning approach, fiagmented planning with hudgetting and budget-based activities, have no authority to managed their own revenue (I00% is given to the district government), there are no clear reward system, lower staffs participation and the same of organizational structure with another public health centre in Indonesia. Beside that, the result also shows that between them have the basic same, comprises of planning process (bottom up planning, integrated planning with budgetting, target based activities, revenue management (a door, more transparant, using incentive criterions), the beginning of self financed process (1 ? of April 2000), legal aspect (District Govemment No. 39/2000) and the stage (intern and extern stage). The diEerencess between them are optirnalization of staifs participation in planning process (higher vs. lower, solid teamwork vs. not, higher support vs. lower, participative vs. representative management), revenue management form (sentralized vs. decentralized), staH`s discipline (higher vs. lower, amano va manual), financial recording and reporting system (computerized vs. manually), self Hnanced process (ready vs. not ready), gradation of change (segmental- vs comprehensive) and reward system formula. Basically, the change being self financed public health centre is very useiiill., - mainly to increase their autonomy and quality of care - , so that can be developed more in the future.